Ruminations by a non-academic general surgeon from the heart of the rust belt.

Monday, April 13, 2009

In the Blink of an Eye

Nick Adenhart, the young Anaheim Angels pitcher, was killed by a drunk driver last week. He was 22 years old and had just thrown six shutout innings for the Angels hours before Andrew Gallo drunkenly drove his van through a red light and slammed into Adenhart's sports car. It's a horrible loss, obviously, and our thoughts go out to his family. He was 22 years old. A pitcher in the Major Leagues. Young and athletic and full of confidence. His whole life stretched out as far as the eye can see. And now he's gone, all that potential and youthful vigor down the drain.

The tragedy prompted a memory of mine from medical school. I was a third year med student on trauma call. It was midday, like 3pm, when a patient rolled in on a backboard, collared and already intubated. All we knew was that a male driver had been struck from behind at a stop sign and EMS on the scene had had to intubate him because he wasn't breathing. As students, we did all the dirty work during a level I trauma; place the foley, do the blood gas stick, make sure there was IV access, etc. I had Foley duty and I wasn't too happy about it because the patient, he seemed to be about a thirty year old male, was sporting a massive erection. At first, I started to smile, formulating jokes in my mind in a typically juvenile medical student way, but I noticed no one was smiling or laughing in the way people do in the operating room when a patient spontaneously becomes erect under general anesthesia. This was different. The trauma attending was shaking his head. I heard fragments of chatter about "spinal cord" and "IV steroids" and it dawned on me what was really happening. He wasn't moving at all. Even though he was intubated, he was awake and blinking his eyes, these wide white terrified eyes, desparately trying to follow the instructions someone kept shouting in his ear; "wiggle your toes, sir!" and "squeeze my hand!". His toes weren't wiggling and his fingers lay motionless on the gurney. I put the Foley in and stepped back against the wall.

The films showed a transection of the cord at C3. He was lucky to be alive but clearly there was little hope of any meaningful neurologic recovery. He was going to be a quadraplegic. Later on his wife showed up. She was dressed up in some sort of work uniform, Sears or Montgomery Ward or something, and she had this harried, almost angry look on her face. We met her in the consultation room and the neurosurgeon bluntly and unequivocally informed her that her husband would never walk again, would never use his hands again, likely would never breathe again on his own. He wanted to do a cervical stabilization procedure to limit the damage already done but there wasn't anything he could go to reverse what had already occured. He told her he was sorry and then he left.

The details of the accident had started to trickle in. The woman's husband had been idling at a stop sign, waiting for the other cars to pass. He was at a standstill, zero velocity, when struck from behind by a pick-up truck. He never saw it coming. The force of the impact caused such a violent whiplash effect that his cervical spine just snapped. Just like that. An ambulance happened to be driving by when it occured; otherwise he would have suffocated and died at the scene.

In the consultation room, the wife was inconsolable. She wailed all hunched over, her back shuddering while we all sat there uncomfortably. What am I supposed to do? she sobbed. What am I supposed to do now? They had three young kids at home. She gathered herself eventually. She sat up straight. She told us that her husband was an accountant who never took chances. He kept two hands on the steering wheel at all times. He always wore his seatbelt and kept a notebook on all the repairs and maintenance work on their cars. He never drove fast. He drove like an old man, she said, almost with a bitter laugh. She shook her head. She went off to find her children.

4 comments:

Anonymous
said...

I've been an EMT for 5 years and am applying to medical school now. I think the thing that I'll miss the most about EMS is being able to say, "I don't know what will happen, the doctors at the hospital will have more information."

Your story is incredibly tragic for everyone involved, and I don't say this to belittle the family's loss and suffering: but I definitely do NOT envy the neurosurgeon.

I remember getting 2 kids, about 17-20 during my trauma rotation at Metro that reminded me of this.

1: kid a was out on the farm, when a hay loader came down, struck him in the head, and axially loaded him. he jumped the facets at t11/12, and came in sporting the erection and now is a paraplegic. was absolutely heartbreaking.

2. a 20ish kid came in after getting shot in the back after refusing to fight someone. he came in, sporting the erection, and had a bullet lodged in the canal at t9, with cord hematoma. he didn't walk again either.

However, for all the depressing ones, there's some amazing ones.

I saw a girl about a month ago who was mildly intox, unrestrained passenger, who struck a deer. she got out, ambulated at the scene, and EMS cleared her. She went home, complained of a bad neck ache when she turned her head. At OSH, she had a ct of the cspine revealing bilateral c1 arch fx and a displaced type 3 odontoid. she ended up haloed with an odontoid screw, but she's walking.

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